Early recognition and management of fetal head trauma with massive subgaleal hemorrhage.

Non-obstetrical fetal head injury is an unusual clinical event. While multiple case reports describe motor vehicle collisions resulting in intrauterine fetal skull fractures, management of these injuries has not been emphasized. We report a case of a depressed fetal skull fracture with massive subgaleal and subperiosteal hemorrhage requiring neurosurgical intervention with good clinical outcomes for both mother and infant dyad.

Alarm safety and oxygen saturation targets in the Vermont Oxford Network iNICQ 2015 collaborative.

OBJECTIVES: To assess progress of neonatal intensive care units (NICUs) participating in the Vermont Oxford Network iNICQ 2015: Alarm Safety Collaborative in achieving Joint Commission 2014 alarm safety goals with respect to oximeters, and to compare patient-level oxygen saturation (SpO2) and oximeter alarm data to local policies. STUDY DESIGN: Prospective multicenter audits in February and August 2015 assessed implementation of policies addressing Joint Commission 2014 Alarm Safety goals, and ascertained SpO2 targets, oximeter alarm settings and compliance with policy-specified SpO2 targets and alarms. RESULTS: Eighty-six NICUs completed both audits. Of 13 policies addressing mandated goals, median (interquartile range) 8 (5, 9) policies were implemented at audit 1 and 9 (6, 11) at audit 2 (P=0.004). At audit 1, 28 NICUs had implemented ⩾9 policies versus 47 at audit 2. For 794 infants <31 weeks gestation, <36 weeks postmenstrual age, and on supplemental oxygen, median SpO2 target lower limit was 88% (interquartile range 87%, 90%; range 75% to 94%), upper limit 95% (interquartile range 94%, 96%; range 85% to 100%). High oximeter alarm was set according to local policy for 63% of infants, for whom SpO2 >97% was less frequent than when high alarm was not set to policy (10.1% vs 21.5%, P=0.006). CONCLUSIONS: Participating NICUs showed significant progress between audits in their implementation of Joint Commission Alarm Safety goals for oximeter monitoring. Oximeter high alarm not set per local policy is associated with increased hyperoxemia in preterm infants. Recommendations to standardize oxygen saturation targets for infants at risk for oxygenation-related outcomes have not been widely adopted.

Transcribed oxygen saturation vs oximeter recordings in very low birth weight infants.

OBJECTIVE: The objective of this study was to compare hand-transcribed oxygen saturation (SpO2) with electronic oximeter data in very low birth weight infants (VLBWI, <1500 g). STUDY DESIGN: Oximeter data were downloaded from birth through 36 weeks postmenstrual age (PMA) for VLBWI before and after interventions to improve neonatal intensive care unit oxygen management. Transcribed SpO2 values were obtained by chart review. Proportions of transcribed and oximetry data in target (85 to 93%), hypoxemic (80 to 84%), and hyperoxemic (≥98%) ranges before and after intervention were compared. RESULT: There were 30,441 oximetry hours before intervention and 54,538 oximetry hours after intervention. Transcribed SpO2 values correlated strongly with oximeter overall. However, during hours on supplemental oxygen, transcribed values significantly overdocumented target range and underdocumented values 80 to 84 and ≥98%. This finding varied by respiratory support and PMA, and increased after intervention. CONCLUSION: Transcribed SpO2 values overdocumented target range and underdocumented hyperoxemic and hypoxemic ranges compared with electronic oximeter data. These results support incorporating electronic oximeter data into medical records.

The Homeodomain Resource: sequences, structures, DNA binding sites and genomic information.

The Homeodomain Resource is an annotated collection of non-redundant protein sequences, three-dimensional structures and genomic information for the homeodomain protein family. Release 3.0 contains 795 full-length homeodomain-containing sequences, 32 experimentally-derived structures and 143 homeo-box loci implicated in human genetic disorders. Entries are fully hyperlinked to facilitate easy retrieval of the original records from source databases. A simple search engine with a graphical user interface is provided to query the component databases and assemble customized data sets. A new feature for this release is the addition of DNA recognition sites for all human homeodomain proteins described in the literature. The Homeodomain Resource is freely available through the World Wide Web at http://genome.nhgri.nih.gov/homeodomain.